Practical steps for an essential part of the treatment plan
STUDY: Mylod D and Lee TH, Journal of Patient Experience 2023;10:1-3
STUDY TYPE: Practical guide
FUNDING: Independent
Background
Hope does not depend entirely on the patient’s beliefs, argues this paper. Clinicians can actively create it through three steps:
- Clarify the patient’s goals
- Demonstrate the will and skill to help
- Lay out a specific pathway forward.
Summary
Hope is not the same as optimism. Optimism is a general belief that things will improve. Hope is tied to a specific, realistic goal, and false hope erodes trust. Even when a cure isn’t possible, there’s still something to hope for: more good time, relief from suffering, or eventually a comfortable death. The goal shifts, but the process of naming it together stays the same.
Qing Ng recently applied this framework in a case report of treatment resistant depression. Even if symptomatic recovery is not likely, Ng recommends asking patients to name their own goals, then break those down into gains that a patient can reach: a few more good days a week, or the return of one specific function they miss most.
Ask what a better week would look like in concrete terms, not just “less depressed.” Naming one attainable target, like sleeping through the night or getting back to a hobby, gives us something to work toward together through lifestyle and behavioral change while waiting for symptoms to improve.
—Chris Aiken, MD
Director, Psych Partners
Editor in Chief, Carlat Psychiatry Report
